Cosme García

Temporary Pacemakers: Current Use and Complications

INTRODUCTION AND OBJECTIVE Temporary pacemakers (TP) are used in the emergency treatment of patients with severe bradyarrhythmia. They are often used in emergency situations and for older patients in poor general condition who are hemodynamically unstable and uncooperative. The aim of this study was to review and analyze the indications, incidence and type of complications associated with TP implanted in our center during a 6-year period. PATIENTS AND METHOD We analyzed significant clinical variables, indication, route of insertion, follow-up, complications, and duration of temporary pacing. RESULTS A total of 568 TP were implanted, and 530 cases were available for review (mean age 74.8 [11] years). The main indications were symptomatic complete AV block (51%), prophylaxis for replacement with a definitive pacemaker (14.7%), blockage in the acute phase of myocardial infarction (12.6%), bradyarrhythmia due to drug intoxication (12.2%), symptomatic sick sinus syndrome (7.5%) and long QT interval or ventricular tachycardia (2.5%). The route of insertion was via the femoral vein in 99% of the cases. The duration of TP use was 4.2 days (range 1 to 31 days). A total of 369 patients (69.6%) required a permanent pacemaker. COMPLICATIONS 34 patients died (6.4%), but only 3 deaths were attributable to TP implantation. Other severe complications were seen in 98 patients (18.5%). Malfunction of the TP occurred in 48 patients (9%) because of electrode displacement. CONCLUSIONS Temporary pacemakers are used in older patients with extreme bradyarrhythmia and occasionally with acute myocardial infarction. Serious complications are not uncommon (22% of all patients), and can range from femoral hematoma to cardiac tamponade and even death (6%). In 9% of the patients the electrode needed to be repositioned because of failure of sensing or loss of ventricular capture.

Duration of complete atrioventricular block complicating inferior wall infarction treated with fibrinolysis

Introduction and objectives The aim of this study was to determine the duration of complete atrioventricular block complicating inferior wall acute myocardial infarction after the administration of fibrinolytic therapy. Patients and Method From 1 January 1992 to 31 January 2002 a total of 449 patients were admitted directly to our hospital with inferior wall acute myocardial infarction in the first 6 hours; 282 of them (64%) received fibrinolytic therapy. Complete atrioventricular block appeared in 39 of these 282 patients (13.8%, group A). Of the 167 patients who did not receive thrombolytic therapy, complete atrioventricular block appeared in 13 (8%, control group). We compared the two groups by analyzing the duration of heart block, time to appearance, hemodynamic repercussion, and treatment required. Results On admission, 38% of the patients in group A and 61% (P=NS) of those in the control group had complete atrioventricular block. Median duration of the block was 75 minutes (10 minutes to 48 hours) in group A and 24 hours (15 minutes to 9 days) in the control group (P=.004). After fibrinolytic therapy was administered, median duration of the block was 45 minutes (5 minutes to 48 hours). A temporary pacemaker was implanted in 43% of the group A patients and 84.6% of the control group patients (P=.01). Conclusion Complete atrioventricular block appears as a complication of inferior myocardial infarction within the first hours after the event. Duration of the block seems to be shorter in patients treated with fibrinolytic therapy.

Duración del bloqueo auriculoventricular completo en el infarto inferior tratado con fibrinólisis

Introduccion y objetivos El objetivo de nuestro estudio es determinar la duracion del bloqueo auriculoventricular completo (BAVC) en el transcurso de un infarto agudo de miocardio (IAM) de localizacion inferior tras la administracion de tratamiento fibrinolitico. Pacientes y metodo Entre el 1 de enero de 1992 y el 31 de enero de 2002 consultaron en primera instancia en nuestro centro 449 pacientes con IAM de localizacion inferior en las primeras 6 h de evolucion. El 64% (282 pacientes) recibio fibrinolisis. En este grupo, 39 (13,8%) pacientes presentaron BAVC (grupo A). En los 167 pacientes no tratados con trombolisis, 13 (8%) casos presentaron BAVC (grupo control). Se comparan ambos grupos y se analizan la duracion y presentacion del bloqueo, la repercusion hemodinamica y la conducta terapeutica seguida. Resultados En el 38% de los pacientes del grupo A habia BAVC en el momento del ingreso frente al 61% de los del grupo control (p = NS). La duracion mediana del bloqueo fue de 75 min (10 min-48 h) en el grupo A y de 24 h (15 min-9 dias) (p = 0,004) en el grupo control. Una vez realizada la fibrinolisis, el BAVC tuvo una duracion mediana de 45 min (5 min-48 h). Se implanto un marcapasos provisional en 17 pacientes del grupo A (43%) y en 11 del grupo control (84,6%) (p = 0,01). Conclusion El BAVC en el IAM de localizacion inferior aparece precozmente. La duracion del bloqueo parece ser menor al realizar la fibrinolisis.

Taponamiento cardíaco por hematoma retroauricular

Durante el postoperatorio de sustitucion de aorta ascendente con tubo valvulado tipo Hamsfield por diseccion aortica tipo A, una paciente presento hipotension con oliguria, sin pulso paradojico. Mediante ecografia transesofagica en la unidad de cuidados intensivos se puso de manifiesto un hematoma pericardico que comprimia la auricula derecha. Se realizo un drenaje subxifoideo mediante una canula de aspiracion bajo control ecocardiografico, se aspiro el coagulo y se soluciono el compromiso hemodinamico.